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. 2014 Aug;211(2):155.e1-6.
doi: 10.1016/j.ajog.2014.02.013. Epub 2014 Feb 13.

Obstetric antecedents to body-cooling treatment of the newborn infant

David B Nelson  1 , Ashley M Lucke  2 , Donald D McIntire  3 , Pablo J Sánchez  2 , Kenneth J Leveno  3 , Lina F Chalak  2
Affiliations

Obstetric antecedents to body-cooling treatment of the newborn infant

David B Nelson et al. Am J Obstet Gynecol. 2014 Aug.

Abstract

Objective: Obstetric antecedents were analyzed in births in which the infant received whole-body cooling for neonatal encephalopathy.

Study design: This retrospective cohort study included all live-born singleton infants delivered at or beyond 36 weeks' gestation from October 2005 through December 2011. Infants who had received whole-body cooling identified by review of a prospective neonatal registry were compared with a control group comprising the remaining obstetric population delivered at greater than 36 weeks but not cooled. Univariable analysis was followed up by a staged, stepwise selection of variables with the intent to rank significant risk factors for cooling.

Results: A total of 86,371 women delivered during the study period and 98 infants received whole-body cooling (1.1 per 1000 live births). Of these 98 infants, 80 newborns (88%) had moderate encephalopathy and 10 (12%) had severe encephalopathy prior to cooling. Maternal age of 15 years or younger, low parity, maternal body habitus (body mass index of ≥40 kg/m(2)), diabetes, preeclampsia, induction, epidural analgesia, chorioamnionitis, length of labor, and mode of delivery were associated with significantly increased risk of infant cooling during a univariable analysis. Catastrophic events to include umbilical cord prolapse (odds ratio [OR], 14; 95% confidence interval [CI], 3-72), placental abruption (OR, 17; 95% CI, 7-44), uterine rupture (OR, 130; 95% CI, 11-1477) were the strongest factors associated with infant cooling after staged-stepwise logistic analysis.

Conclusion: A variety of intrapartum characteristics were associated with infant cooling for neonatal encephalopathy, with the most powerful antecedents being umbilical cord prolapse, placental abruption, and uterine rupture.

Keywords: perinatal acidemia; systemic hypothermia.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1
Figure 1
Multivariable analysis after step-wise selection (p ≤ 0.10) of risk factors for newborn whole-body cooling. Odds ratios (95%CI) are shown in logarithmic scale.
See this image and copyright information in PMC

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